Koretsi, Vasiliki and Eliades, Theodore and Papageorgiou, Spyridon N. (2018) Oral Interventions for Obstructive Sleep Apnea An Umbrella Review of the Effectiveness of Intraoral Appliances, Maxillary Expansion, and Maxillomandibular Advancement. DEUTSCHES ARZTEBLATT INTERNATIONAL, 115 (12). 200-+. ISSN 1866-0452,
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Background: The effectiveness of intraoral appliances (IOA), maxillary expansion (ME), and maxillomandibular advancement (MMA) in the treatment of children and adults with obstructive sleep apnea (OSA) has not yet been adequately assessed. Methods: An umbrella review was performed based on established guidelines for evidence-based medicine. Data synthesis was performed only from randomized controlled trials with Paule-Mandel random-effects meta-analyses/meta-regressions using mean differences (MDs) and 95% confidence intervals (CIs) and was followed by the qualitative evaluation of the meta-evidence. Results: 29 systematic reviews were included, 7 of which provided quantitative data. IOA were effective in improving apnea hypopnea index (AHI) compared to both, placebo appliances (12 trials; 525 patients; MD = -11.70; 95% CI: [-15.38; -8.01]; p < 0.001) and no treatment (1 trial; 24 patients; MD = -14.30; [-21.59; -7.01]; p < 0.001). Only the former comparison was supported by robust meta-evidence. Effectiveness of IOA as measured by the Epworth Sleepiness Scale, on the other hand, was not supported by robust meta-evidence. No randomized or prospective controlled trials were found on the effectiveness of ME (conventional or surgically assisted) and MMA. Conclusion: Intraoral appliances are effective in reducing AHI and their use is substantiated by robust evidence. There is no evidence from high-quality research to support treatment with ME (conventional or surgically assisted) or MMA in patients with OSA.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | POSITIVE AIRWAY PRESSURE; RANDOMIZED CONTROLLED-TRIALS; SYSTEMATIC REVIEWS; SURGICAL MODIFICATIONS; METAANALYSIS; EFFICACY; CPAP; HYPOPNEA; CHILDREN; MANAGEMENT; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Kieferorthopädie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 11 Mar 2020 13:01 |
| Last Modified: | 11 Mar 2020 13:01 |
| URI: | https://pred.uni-regensburg.de/id/eprint/14877 |
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